2020-05-14T22:00:37-05:00 2019-06-30 350921680 CROWE LLP 225 West Wacker Drive Suite 2600 Chicago IL 606061224 990 2018-07-01 390808480 St Nicholas Hospital of the Hospital Sisters of the Third Order of St Franc is STNI 9204598300 3100 SUPERIOR AVENUE Sheboygan WI 530811948 PATRICIA ALLEN DIVISION CHIEF FINANCIAL OFFICER 2020-05-14 true Mallory Fairless P01321579 3128997000 2018 2020-09-23 17:36:50Z St Nicholas Hospital Justin Selle 3100 SUPERIOR AVENUE Sheboygan WI 530811948 126709530 false 0928 X WWW.STNICHOLASHOSPITAL.ORG X 1890 WI TO CARRY FORWARD THE HEALING MINISTRY OF THE HOSPITAL SISTERS OF ST. FRANCIS AS PART OF THE HEALTH MINISTRY OF THE ROMAN CATHOLIC CHURCH. 14 12 503 149 69950 0 2089474 35215 113375359 121162569 1247119 115482 56757 -177698 116768709 121135568 0 0 27415594 28664303 0 0 81505554 88249072 108921148 116913375 7847561 4222193 133451695 139336891 31666681 39355352 101785014 99981539 X ST. NICHOLAS HOSPITAL IS DEDICATED TO SUFFERING HUMANITY FOR HIS SAKE, AND IS COMMITTED TO PROVIDING HIGH QUALITY, COMPASSIONATE CARE WITHOUT REGARD FOR RACE, CREED, OR ABILITY TO PAY. THE HOSPITAL'S CORE VALUES OF RESPECT, CARE COMPETENCE AND JOY ARE LIVED BY ALL WHO SERVE HERE, AND FELT BY ALL WHO RECEIVE HEALTHCARE SERVICES AT ST. NICHOLAS HOSPITAL. false false 11099290 25630893 SURGICAL SERVICES - SEE SCHEDULE O 3303113 15585901 RADIOLOGY SERVICES - SEE SCHEDULE O 2126250 8851558 EMERGENCY SERVICES - SEE SCHEDULE O 80330929 71024267 OTHER PROGRAM SERVICES ST. NICHOLAS HOSPITAL PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL SERVICES TO THE COMMUNITY. BESIDES THE THREE LARGEST PROGRAM SERVICES IDENTIFIED IN PART III, ST. NICHOLAS HOSPITAL PROVIDES ADDITIONAL SERVICES INCLUDING A MEDICAL/SURGICAL FLOOR, INTENSIVE CARE UNIT, WOMEN AND INFANT SERVICES, HOME HEALTH AND HOSPICE CARE, CARDIAC SERVICES, WOUND CARE, RADIATION THERAPY, ORTHOPEDIC SERVICES, RENAL DIALYSIS, SLEEP CENTER SERVICES, AND A VARIETY OF ADDITIONAL MEDICAL SERVICES. ST. NICHOLAS HOSPITAL PROVIDES AN ARRAY OF COMMUNITY HEALTH SERVICES INCLUDING, BUT NOT EXCLUSIVE TO THE FOLLOWING, DIABETIC SCREENINGS, FLU SHOTS, FOOT CLINICS AND A VARIETY OF COMMUNITY EDUCATION CLASSES. IN ADDITION, ST. NICHOLAS HOSPITAL PARTNERS WITH SEVERAL PHYSICIAN GROUPS AND OTHER JOINT VENTURES THAT PROVIDE NEEDED MEDICAL SERVICES TO THE COMMUNITY. 80330929 71024267 96859582 true true false true false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false true true false false false true 20 0 true 503 true true true false false false false false true false false false false false X 14 12 false false false false true true true true true false false true true true true true true true true true true X Dawn Gracyalny 9204984604 835 S Van Buren St Green Bay WI 54301 X TIMOTHY KELLNER 2018 VICE CHAIR & 2019 Chair 1.0 0 X X 0 0 0 JAMIE LOIACONO 2019 Secretary 1.0 0 X X 0 0 0 THERESE B PANDL INTERIM PRES/ CEO EASTERN WISCONSIN DIVISION 12.0 48.0 X X 0 924387 174302 Justin Selle President & CEO as of 8/20/18 20.0 0 X X 0 158718 19143 DAVID VAN DE WATER JD 2018 CHAIR 1.0 0 X X 0 0 0 JOHN WENIG 2018 SECRETARY & 2019 Vice Chair 1.0 0 X X 0 0 0 John Brotz BOARD MEMBER 1.0 0 X 0 0 0 CARL CLAERBOUT BOARD MEMBER 1.0 0 X 0 0 0 MICHAEL W COTTRELL BOARD MEMBER/HSHS CFO 1.0 59.0 X 0 828161 189746 SR MAUREEN FAGAN OSF BOARD MEMBER 1.0 2.0 X 0 0 0 Lindsey Harrison-Eirich BOARD MEMBER 1.0 0 X 0 0 0 Sara Smith MD BOARD MEMBER 1.0 0 X 0 0 0 WILLIAM TRAGER MD BOARD MEMBER 1.0 0 X 0 0 0 STEPHEN WERNER MD BOARD MEMBER 1.0 0 X 0 0 0 ANN M CARR TREASURER 0.3 59.7 X 0 329829 110463 MARY MARTIN CHIEF NURSING OFFICER 40.0 0 X 190688 0 56480 GREG SIMIA DIVISION CFO 10.0 30.0 X 0 456456 89224 ANDREA M ANGOTTI PHARMACIST 40.0 0 X 158193 0 80298 SHALON EDSON DIRECTOR - CLINICAL 40.0 0 X 128827 0 22643 Tayna Konitzer Divisional Director 40.0 0 X 118001 0 29122 MELISSA PALECEK PHARMACY MANAGER 40.0 0 X 154926 0 14706 CEANNE SIMMELINK PHARMACIST 40.0 0 X 127755 0 35372 ANDREW J BAGNALL FORMER PRES/CEO WESTERN WI DIV 0.0 40.0 X 0 611303 108512 878390 3308854 930011 12 true true false TOTAL MSP LLC 221 W COLLEGE AVE FLOOR 2 APPLETON WI 54911 CONTRACT LABOR 1305561 PREVEA PO BOX 19070 GREEN BAY WI 543079070 SHARED LABOR & SERVICES 996105 COMPASS ONE PO BOX 102289 ATLANTA GA 30368 FOOD & HOUSEKEEPING SERVICES 731578 EAGLE TELEMEDICINE 280 INTERSTATE NORTH CIRCLE SE ATLANTA GA 30339 TELEMEDICINE SERVICES 487737 ANESTHESIOLOGY ASSOCIATES PO BOX 68-6160 MILWAUKEE WI 53268 ANESTHESIA 385302 18 35215 35215 NET PATIENT SERVICE REVENUE 621990 121092619 121092619 LABORATORY OUTREACH REVENUE 621500 69950 69950 0 0 0 0 121162569 420383 420383 1256406 1765062 -508656 0 -508656 -508656 337207 3166792 3808900 337207 -642108 -304901 -304901 OTHER OPERATING REVENUE 900099 275160 275160 Gift Shop and Auxiliary Revenue 453220 55798 55798 0 0 0 0 330958 121135568 121092619 69950 -62216 X 205985 153582 52403 22557135 16818696 5738439 -188640 -140650 -47990 4624799 3448250 1176549 1465024 1092322 372702 419702 419702 41192317 32460081 8732236 0 66863 62014 4849 3373872 2346979 1026893 245142 230494 14648 430463 418706 11757 -22814 -22814 3361775 2376556 985219 252803 252803 SUPPLIES - MED/SURG/O2/DRUGS 16059709 15812474 247235 PREVEA INVESTMENT 13867674 13867674 BAD DEBT EXPENSE 2537669 2537669 MEDICAID ASSESSMENT TAX 2040796 2040796 4423101 3081136 1341965 0 116913375 96859582 20053793 0 1450 1450 3530583 2028758 13573003 14775017 0 0 0 1992023 2316049 412955 373643 145597107 79226515 50987194 66370592 60564986 50363860 0 1083558 1164651 1305943 1942871 133451695 139336891 9467164 15715399 157695 112381 16202092 15228314 0 5839730 8299258 31666681 39355352 X 94173829 92496895 5914770 5788229 1696415 1696415 101785014 99981539 133451695 139336891 X 4222193 -315874 -5709794 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 8367 8367 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY ST. NICHOLAS HOSPITAL (THE HOSPITAL) IS A MEMBER OF THE CATHOLIC HEALTH ASSOCIATION ("CHA"), THE WISCONSIN HEALTH ASSOCIATION ("WHA"), AND THE AMERICAN HOSPITAL ASSOCIATION ("AHA"). AS A MEMBER OF THESE ORGANIZATIONS, THE HOSPITAL PAYS DUES, WITH PART OF THESE DUES BEING ATTRIBUTABLE TO LOBBYING FEES PAID BY THE ORGANIZATIONS. THE AMOUNT LISTED IS THE AMOUNT ATTRIBUTABLE TO THE HOSPITAL FROM ITS DUES PAID. THE ASSOCIATIONS THE HOSPITAL PAYS ARE AS FOLLOWS: - AMERICAN HOSPITAL ASSOCIATION ("AHA") AT 22.73% LOBBYING EXPENSE - CATHOLIC HEALTH ASSOCIATION ("CHA") AT 3.52% LOBBYING EXPENSE - WISCONSIN HOSPITAL ASSOCIATION ("WHA") AT 13.60% LOBBYING EXPENSE THE TOTAL AMOUNT OF ANNUAL DUES PAID TO EACH ASSOCIATION IS MULTIPLIED BY THE PERCENTAGE OF DUES ALLOCATED TO LOBBYING EXPENSE TO CALCULATE THE TOTAL LOBBYING EXPENDITURES PAID. 1715010 1715010 52360684 20267239 32093445 2775738 845832 1929906 41560182 29347247 12212935 47185493 28766197 18419296 66370592 UNAMORTIZED BOND PREMIUM & ISSUE COSTS NET 500401 OTHER LONG TERM LIABILITIES 355620 ACCRUED PENSION 7443237 8299258 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote HSHS and the Foundation are Illinois not-for-profit organizations as described in Section 501 (c) (3) of the Internal Revenue Code (the Code) and are exempt from federal income taxes on related income pursuant to Section 501 (a) of the Code. Kiara, Inc. is an Illinois for-profit corporation that recognizes income taxes under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using the enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Management considers projected future taxable income and tax planning strategies in making this assessment. Based upon the level of historical taxable losses and projections for future taxable losses over the periods for which the deferred tax assets are deductible, management believes it is more likely than not Kiara, Inc. will not realize the majority of the benefits of these deductible differences. Full valuation allowances have been applied against the deferred tax assets attributable to the net operating loss carryforwards not realized as of June 30, 2019 and 2018 in the accompanying consolidated financial statements due to the uncertainty of realization. HSHS recognizes the tax benefit from an uncertain tax position only if it is more likely than not the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. As of June 30, 2019 and 2018, HSHS does not have any liabilities for unrecognized tax benefits. true true X true X true X true true false true true 3583598 2467611 1115987 0.0098 13257566 5200431 8057135 0.0704 589853 408523 181330 0.0016 0 0 17431017 8076565 9354452 0.0818 188884 0 188884 0.0017 20291 0 20291 0.0002 0 0.0 0 0.0 117713 0 117713 0.0010 0 0 326888 0 326888 0.0029 0 0 17757905 8076565 9681340 0.0846 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 2537669 203395 32623322 55112252 -22488930 X true true 1 1 ST NICHOLAS HOSPITAL 3100 SUPERIOR AVE SHEBOYGAN WI 530811948 www.stnicholashospital.org 37 X X X ST NICHOLAS HOSPITAL 1 false false true X X X X X X X X X 17 true true true true X https://www.stnicholashospital.org/www-sns/media/SNS-PDFs/About/CHNA-SNS.pdf X true 17 true https://www.stnicholashospital.org/www-sns/media/SNS-PDFs/About/CHIP-SNS.pdf false true X 200.0 400.0 X X X X X X true true X X X true X http://www.hshs.org/FAP X http://www.hshs.org/FAP X http://www.hshs.org/FAP X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E Yes, the significant health needs are a prioritized description of the significant health needs of the community and were identified through the CHNA process. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - HSHS St. Nicholas Hospital. Hospital Sisters Health System and HSHS St. Nicholas Hospital are committed to promoting and defending human dignity, caring for persons living in poverty and other vulnerable persons, promoting the common good and stewarding resources. We believe that the CHNA process must be informed by input from the poor and vulnerable populations we seek to serve. To ensure that the needs of these groups were adequately represented, we included representatives from Sheboygan County Health and Human Services (Public Health, Aging & Disability Resource Center, and Child & Family Services); various Sheboygan County departments including Head Start, Probation & Parole, Victim/Witness Services, Veterans Services; Love, Inc.; Sheboygan County Interfaith Organization; local school districts; Sheboygan County Interfaith; Partners for Community Development; Family Resource Center of Sheboygan County; and Safe Harbor in the FY2018 CHNA process. These organizations serve the under-resourced in our community, including low-income seniors, children living in poverty, families who struggle with shelter and food insecurity, veterans, and victims of domestic violence. Representatives of these organizations, who work directly with their constituents, have extensive knowledge and quantifiable data regarding the needs of their service populations. Actively including these organizations in the CHNA process was critical to ensure that the needs of the most vulnerable persons in our communities were being shared and addressed in the CHNA process and included in the development of related implementation strategies. Internal HSHS St. Nicholas Hospital spent more than a year developing the CHNA, identifying and prioritizing community health needs for its service area and formulating an implementation plan to guide ongoing population health initiatives with like-missioned partners and collaborators. These planning and development activities included the following internal and external steps: Convene the HSHS Eastern Wisconsin Division community benefit team. Determine internal capacity for the collaborative process. Allocate monetary resources to support the community-wide effort. Share results of the "Call to Action" event and World Cafe meetings in order to develop the implementation plan. Present to hospital leadership to seek approval for colleagues to track and document community benefit efforts in CBISA Share the results of the CHNA and obtain feedback for the implementation plan from the Hospital Advisory Committee. Present the CHNA and implementation plan to the hospital Board for approval External HSHS St. Nicholas Hospital also leveraged existing relationships to gain additional insights into community health needs in the hospital's service area. External components and steps included: Identify the methodology to be used for this update. Utilize local community health survey, a comprehensive phone-based survey, which gathers data on adult behavioral and lifestyle habits and the respondent's household information. This report was sponsored by the collaborative group and funded by HSHS St. Nicholas Hospital, Lakeshore Community Health Care and Aurora Health Care. Data was analyzed and prepared by JKV Research, LLC. Data collection was conducted by Management Decisions Incorporated. Interview 32 key community stakeholders for the key interview summary report. This report is prepared by the Center for Urban Population Health (CUPH). Engage CUPH to complete a secondary data report. Convene a planning committee to host the "Call to Action" event. Work with the CHNA committee to determine priorities prior to the "Call to Action" event. Host a Call to Action event on September 28, 2017 to encourage key community stakeholders to actively participate in the CHNA process. Prior to the event, attendees had the opportunity to review preliminary community health data (secondary data report, key informant report, healthy survey report and a data report snapshot). One hundred and fifteen individuals attended the Call to Action event. As part of the Call to Action, a presentation was given by members of the CHNA steering committee and Healthy Sheboygan County Council Co-Leaders. The large group was divided into small groups to discuss root causes and potential goals within the priority action areas. The framework for this activity was the Tearless Logic Model, a tool from the Global Journal of Community Psychology Practice that breaks the logic model process down into a series of manageable, jargon-free questions. As part of the evaluation process, attendees were asked to complete an initial survey. Using survey date, event organizers compiled a list of what is currently occurring within our community related to each priority area. After the event, the CHNA steering committee evaluated the feedback from the facilitated discussions to refine the priority areas and determine goals for the World Cafe discussions. Host three World Cafe discussions for each of the identified priority action areas: Responsible substance use (November 6, 2017); Healthy nutrition and physical activity (November 7, 2017); and Positive mental health (November 13, 2017). Invitations were extended to members of the HSC 2020 committees and "Call to Action" attendees, who were also encouraged to share the invitation with others who would be interested in participating; 87 individuals attended the cafes. The purpose of the World Cafe discussions was for participants to propose effective implementation strategies to address the identified needs: Responsible substance use * Enhance primary prevention and education * Create a responsible substance use culture * Create a recovery community Positive mental health * Build a trauma informed/resilient community * Increase access to mental health services * Prevent suicide Healthy nutrition and physical activity * Create a culture of health eating * Increase access to healthy foods to address food security * Promote a lifestyle of physical activity * Promote best practice worksite wellness Analyze data collected at "Call to Action" and World Cafe events. Work with the CHNA committee and subject matter experts to develop action plans for community action groups. Work with the CHNA committee on 2018 follow-up meeting to review community health improvement plan. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - St. Vincent Hospital. AURORA SHEBOYGAN MEDICAL CENTER Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - HSHS St. Nicholas Hospital. HSHS St. Nicholas Hospital partnered with several community organizations, including Healthy Sheboygan County 2020, Lakeshore Community Health Center, Sheboygan County Division of Public Health, United Way of Sheboygan County, and University of Wisconsin-Extension - Sheboygan County to complete the Community Health Needs Assessment. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - HSHS ST. NICHOLAS HOSPITAL. HSHS St. Nicholas Hospital provides a range of Community Benefit activities and programs that furthers our mission and long-standing commitment to our community. In many cases, these Community Benefit initiatives, which often relieve a burden that would otherwise be carried by government, would not exist without the leadership role played by HSHS St. Nicholas Hospital. HSHS St. Nicholas Hospital's FY2018 Community Health Needs Assessment (CHNA) surfaced the following health focus areas to be addressed in collaboration with Aurora Sheboygan Memorial Medical Center, clinics, and community organizations: Mental Health Goal: In partnership with the Health and Human Services Divisions of Public Health, Healthy Sheboygan County 2020 and other organizations, promote positive mental health. Long-term performance indicators: * By June 30, 2021, decrease the average number of mentally unhealthy days reported in the past 30 days from 3.3 to 3.0 (Source: 2016 County Health Rankings) * By June 30, 2021, decrease Sheboygan County's suicide rate from 13.0 per 100,000 to 12.5 per 100,000. (Source: Wisconsin Dept. of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Interactive Statistics on Health (WISH) data query system). The Healthy People 2020 target for the United States is 10.2 per 100,000. Mental Health Strategy One: Build a trauma informed/resilient community HSHS St. Nicholas Hospital (SNS), in partnership with Sheboygan County Health and Human Services, and other organizations, will promote and support education on trauma-informed care. The hospital refocused the strategy to align with Healthy Sheboygan County 2020 (HSC 2020) and expanded the focus to include building a resilient community. The HSC 2020 Building a Resilient Community Action Team is using the Strengthening Families model to operationalize resiliency with protective factors as guide to action with a focus on youth. In alignment with the focus on building resiliency within the youth of our community, SNS supported the following strategies, which align with the promotion of positive mental health: Above and Beyond Museum Family Access Membership SNS will provide funds to support the launch the Above and Beyond Children's Museum Family Access Membership to increase access to museum resources by children in our community. The family access program supports positive activities, promotes youth mental health, and aligns with the HSC2020 Building a Resilient Community Action Team. FY2019 Outcomes: In June 2019, the hospital provided funding ($2,000) to the Above and Beyond Children's Museum for the Family Access Membership Program. SNS partnered with the Kohler Company Foundation to support initiation of this program. Mindfulness in the School Program SNS provided a three-year grant (FY2017-FY2019) to Mental Health America (MHA) in Sheboygan County to expand their Mindful Classroom Initiative. MHA utilizes a social-emotional, evidence-based curriculum developed by Growing Minds in classrooms in Sheboygan County. During this 10-week program, students learn how to train their attention and focus, use their five senses mindfully, be more aware in the present moment, and pause to make meaningful choices. Students also learn to recognize their thoughts and emotions, which enhance social skills and the quality of relationships they experience with others. These skills also create calmer classrooms and more productive learning environments. FY2019 Outcomes: During the fall of 2018, 23 classrooms and more than 446 students in Sheboygan County participated in MHA's Sheboygan County Mindful Classroom Initiative. Feedback from students and teachers indicate the program is having a positive impact: "I think mindfulness is amazing. It calms me down and makes me feel better. Thanks for teaching it to us!" - 5th grade student. "I appreciated the opportunity to learn new tools for my toolbox to help my students as well as my own children. Your time spent with us has made a great impact already and will continue long after you leave us. Gifts that continue to give after they are given are amazing. We will continue to be blessed because of the time you have spent with us. Thank you for being awesome and investing in our future." - 4th grade teacher Outcome measurements were calculated based on teacher and student pre and post-self-report surveys: * 80 percent of students now notice when their minds wander (35 percent increase). * 80 percent of students reported they could focus better in the classroom (41 percent increase). * 71 percent of students reported they take a pause before reacting to situations (57 percent increase). * 78 percent of students reported the ability to calm down easier (56 percent increase). * 82 percent of students reported noticing their emotions (a 45 percent increase). * 78 percent of students reported they're able to find ways to relax when stressed (a 55 percent increase). * 100 percent of educators reported calmer classrooms after participating in MCI. * 100 percent of educators reported MCI was beneficial to their students. Mental Health Strategy Two: Promote and support suicide prevention: Question Persuade Refer (QPR) QPR is the most widely taught gatekeeper training in the world and is designed to help participants gain an awareness of statistics, known risk factors, and recognizable behaviors. It shares a proven three-step process for suicide intervention. Training is 60 to 90 minutes. While QPR is not intended to be a form of counseling or treatment, it is intended to offer hope through positive action. Four SNS/Prevea staff members are trained as QPR instructors, who are part of a community cadre of 20 QPR trainers. In 2018, these 20 trainers provided 20 trainings to more than 400 individuals, including hospital staff, church lay persons, community health care providers, and college students. FY2019 Outcomes: At each session attendees complete pre and post sessions evaluation. Feedback from participants indicate that QPR is having a positive impact: This was empowering. Thank you for equipping me to be a force for good in Sheboygan; Excellent and thorough presentation on a very sensitive subject; and I had some previous knowledge, but this made me feel a lot more confident with my current ability to help someone in crisis. Pre and post survey outcomes included: * 83 percent of attendees can now identify the warnings signs of suicide (overall increase of 40 percent). * 84 percent of attendees now know what questions to ask when someone is suicidal (overall increase of 64 percent) and 84 percent reported they know how to ask these questions (overall increase of 71 percent). * 87 percent of attendees know where to go for help and what resources to provide should someone share they are suicidal (overall increase of 48 percent). * 91 percent of attendees reported QPR training helped dispel myths or misconceptions about suicide. There is Hope Walk SNS Community Benefit provided financial and in-kind donations (printing, educational booth/event staffing) to support the Mental Health America in Sheboygan County's 13th annual There is Hope walk, that promotes suicide prevention. FY2019 Outcomes: Nearly 600 people attended, and the event raised approximately $40,000 for community suicide prevention programming. Mental Health Board Hospital staff actively participated on the Board of Mental Health of America in Sheboygan County (MHA); serve on the Personnel and Finance Committee. FY2019 Outcomes: Hospital staff served more than 35 hours on the MHA Board. Service included hiring a new Executive Director and actively serving as a member of the advisory committee for Open Door, a drop-in center for individuals with mental health challenges run by MHA. Mental Health Strategy Three: Increase Access to Mental Health Services HSHS St. Nicholas Hospital will actively support Mental Health American (MHA) to maintain a comprehensive list of mental health providers in the county on the MHA website. The hospital will explore opportunities to partner with MHA and other community organizations to define the access to mental health services issues within our community. Mental Health/AODA Resource Fair As part of HSC 2020 Access Action Team strategies a Mental Health/AODA Resource Fair was held on May 14, 2019 and SNS was an active member of the planning committee along providing funding for the event. FY2019 Outcomes: More than 200 community members including 115 participants, 86 individual professionals from 47 vendor organizations, and 17 volunteers partnered to learn about resources to improve their own lives, the lives of loved ones, or of those colleagues they work with to build healthier communities to live and play in. Participant evaluations indicated that 100% of the attendees learned about new resources; Schedule H, Part V, Section B, Line 11 Facility , 2 Facility , 2 - HSHS St Nicholas Hospital. 74% of participants planned to follow up with a resource they learned about at the fair; and 63% of participants stated their attitudes or behaviors changed by attending the fair. Mental Health/AODA Gap Analysis The Mental Health Access Action Team continues work on the mental health gap analysis which will also include AODA focusing on the development of tools to assess the different groups (key informants, focus groups and community). The goal is to gather stakeholders and present findings and work on next steps identified from the report in the first quarter of 2020. FY2019 Outcomes: SNS has partnered with the Center for Urban Population Health (CUPH) to assist in the strategic planning, implementation, and writing of the report. SNS is an active member of the planning group for this initiative. Support initiation of new dual - licensed position at Federally Qualified Health Center Please refer to the detailed description under AODA. Alcohol and Other Drug Abuse (AODA) Goal: In partnership with the Health and Human Services Division of Public Health, Healthy Sheboygan 2020, and other organizations, create a responsible substance use culture. Long Term Performance Indicators: By June 30, 2021, decrease binge drinking among adults by three percent to 25 percent. By June 30, 2021, decrease the number of opioid deaths by five percent. By June 30, 2021 decrease the number of opioids prescribed in our community by ten percent. AODA Strategy One: Enhance primary prevention and education- medication storage and disposal Medication Take Back Events SNS is an active member of the planning group for the community-wide Medication Take Back event which is held at five county locations two times each year. The hospital host and staff the Sheboygan site. FY2019 Outcomes: At the October 2018 collection, more than 400 pounds were collected from the five locations with over 250 pounds being collected at HSHS St. Nicholas Hospital. In April 2019, collections from the five locations totaled more almost 450 pounds with over 240 pounds being collected at HSHS St. Nicholas Hospital. During these events, approximately 200 people dropped off medication for disposal at the hospital site. Hospital employees from Community Benefit, Plant Services and The Green Team staff this event. The hospital also supported these medication take back events by developing marketing materials and funding ads in local newspapers to share information with our partners and throughout our community. As part of a grant, Healthy Sheboygan County 2020 was able to obtain medication lock/bags to increase medication safety within our community. They partnered with community agencies to distribute the lock boxes/bags to increase medication safety within our community. HSHS St. Nicholas was an active part of the action team who planned and distributed the boxes/bags. Providers from Prevea Behavioral Care participated in this program and had boxes/bags for patients. AODA Strategy Two: Enhance primary prevention and education - Narcan (Naloxone) With grant funding, Healthy Sheboygan County 2020 hosted two Narcan training sessions with the support of the Aids Resource Center of Wisconsin and HSHS St. Nicholas Hospital. The general public, members of community organizations and medical providers were invited to attend the sessions. FY2019 Outcomes: Hosted one Narcan training session at Lakeland University and one at Lakeshore Community Health Care; in total, 32 people attended the two training sessions. Of the completed evaluations received, 93 percent of attendees felt the presentation was easy to understand, and more than 70 percent of attendees felt the information will be of immediate use to them. Feedback received included: "Easy to comprehend and understand"; and "The training was very easy to follow, and the information was delivered in a way that made the topic less intimidating." AODA Strategy Three: Enhance primary prevention and education - Alcohol Healthy Sheboygan County 2020's Responsible Substance Use Action Team has included alcohol as a substance that they are addressing. HSHS St. Nicholas Hospital is an active member of this team. Initial discussion focused on the development of strategies which target and align with the capacity and readiness for change within our community. FY2019 Outcomes: Based on these discussion and strategies are being developed to address binge drinking and underage drinking. Current efforts include the development of a Festival Toolkit to decrease access to alcohol at community events for underage individuals. AODA Strategy Four: Enhance primary prevention and education - Prescription medication Healthy Sheboygan County 2020 (HSC 2020) in cooperation with The Sheboygan County Aging and Disability Resource Center held a community conversation about the opioid epidemic. The discussion and presentation focused on the factors that led to the opioid problem, how to recognize signs of opioid and prescription drug abuse and explore simple ways for community members to get involved in prevention efforts. HSHS St. Nicholas staff and a member of the Sheboygan County Drug Meg Unit presented. FY2019 Outcomes: Ten community members attended the community conversation. In addition to the presentation, a medication take back event was held at the Resource Center. AODA Strategy Five: Increase access to treatment The hospital will provide funding for the initiation of new dual- licensed position in behavioral health and substance abuse at Lakeshore Community Health Care, a Federally Qualified Health Center, to increase access to services for the uninsured and underinsured in the community. FY2019 Outcomes: Funding was provided for a new dual licensed behavioral health/substance abuse position at Lakeshore Community Health Center. This position will be incorporated into their teams which consist of medical, behavioral health and case management. This model was created based on extensive research on evidence-based strategies for providing effective care to the identified needs of their target population and broader community. AODA Strategy Six: Create a recovery community The hospital will partner with community agencies to promote and increase access to recovery support for individuals with substance misuse and abuse issues. FY2019 Outcomes: Starting on October 1, 2018, HSHS St. Nicholas Emergency Department began to offer ED2Recovery services to patients who are seen in our emergency department with a diagnosis of opioid use disorder. ED2Recovery connects people with program staff living in recovery from opioid addiction trained to offer support. Program staff are known as peer specialists or recovery coaches. Hospital staff contacts ED2Recovery staff when they have a candidate for the program. ED2Recovery staff introduces the patient to resources designed to help the person find a path to wellness prior to their release from the hospital. ED2 Recovery peer specialists regularly checks on the person after they leave the hospital to support them reaching their goals. AODA Strategy Seven: Advocate and support policy change related to alcohol and drug abuse The four hospitals in HSHS's Eastern Wisconsin Division including HSHS St. Nicholas Hospital continue to focus our Joint Advocacy/Community Benefit efforts on the opioid epidemic. FY2019 Outcomes: The hospital continued to advocate on behalf of our communities to let our elected officials know that opioid and methamphetamine abuse continue to be major issues. In addition, HSHS St. Nicholas Hospital colleagues attended the annual WHA Advocacy Day. More specifically, the hospital has raised the awareness regarding the following issues and offered innovative solutions to addressing the problem: Opioid epidemic: How can we work together to combat opioid abuse; 340B funding: If CAH and DSH hospitals can continue with these savings, we can use these funds to improve education and awareness around the opioid epidemic; Telemedicine: Removing regulatory burden. By doing so we can better reach the patients that need our help; and Behavioral health: Provider payment increases and regulatory reform. This is key to providing comprehensive care for those that suffer from opioid addictions. In addition to the above efforts other ways in which we are working to increase access to services include the hospital's funding support for the initiation of the dual licensed behavioral health/substance abuse professional at Lakeshore Community Health Care and the active participation of staff in the Mental Health/AODA Gap Analysis described above. Mental Health/AODA Gap Analysis Please refer to the detailed description under Mental Health. Obesity and Nutrition Goal: In partnership with Health and Human Services Division of Public Health, Healthy Sheboygan County 2020 and other organizations, promote healthy nutrition and physical activity. Schedule H, Part V, Section B, Line 11 Facility , 3 Facility , 3 - HSHS St. Nicholas Hospital. Long-term performance indicators By June 30, 2021, increase consumption of fruits to two servings on an average day by three percent. By June 30, 2021 increase consumption of vegetables to two servings per day on an average day by three percent. By June 30, 2021, increase physical activity in a typical week by three percent. Obesity and Nutrition Strategy One: Create a culture of healthy eating The hospital, in partnership with Healthy Sheboygan County 2020 and the Sheboygan County Food Bank (SCFB), will promote and provide healthy food choices in food pantries, empowering the people who use the food pantries to make the best nutritional choices for themselves and their families. The hospital will plant an onsite garden and donate all produce to the Sheboygan County Food Bank. The food bank provides food to 12 community food pantries. The hospital will partner with HSC 2020 and the SCFB to develop a produce collection program -- Produce for Pantries -- for employers within our community. FY2019 Outcomes: Expanded the Produce for Pantries to include the two major hospital systems, two county school districts and multiple locations/departments within the Kohler Company in FY2019 to increase the amount of fresh produce at SCFB pantries for food pantry clients. Fifteen food pantries within our community received produce as part of this program in FY2019. HSHS St. Nicholas Hospital also provided in-kind marketing for the promotional materials and funding for the equipment. In addition to collecting donations from hospital staff, the hospital planted a raised bed garden and donated the produce to the Produce for Pantries program. During the 2018 summer growing season almost 100 pounds of produce was donated. Obesity and Nutrition Strategy Two: Increase access to healthy foods to address food insecurity Double Your Bucks (DYB) Adequate food and nutrition was identified as one of the priority health needs of our community. The Healthy Sheboygan County 2020 food and nutrition action planning group has been working with the local farmer's market to encourage customers using EBT for Food Share (electronic transfer, formerly known as food stamps) to purchase fruits and vegetables. The planning group worked to enable vendors to accept EBT. FY2019 Outcomes: With funding from HSHS St. Nichols Hospital, the "double your bucks" (DYB) program was started during the 2016 Farmers Market to double the purchasing power of EBT when used for fruits and vegetables up to a $10 twice a month. Due to the positive response from customers, DYB is available every market day - twice a week vs. two times a month. Of customers surveyed by the Farmer's Market staff, 75% consumed on average three servings of vegetables during the summer Farmers Market, which translates to DYB participants achieving the recommended goal for HSC 2020 vegetable consumption. The funds supported the Farmers Market Intern which increased capacity and access to enhance DYB program impact. Sheboygan County Food Bank The hospital will partner with Sheboygan County Food Bank to support their efforts to provide healthy food options for their food pantries network. FY2019 Outcomes: The hospital provided monetary support to help SCFB purchase a large freezer and committed to providing ongoing support for two years to help them "fill the freezer." The purchase of the freezer increased SCFB's capacity to receive donations of perishables such as meat, fresh fruits, and vegetable to be distributed to their network of food pantries. In addition, hospital staff actively serve on the SCFB Board including membership on the newly formed Anti-Hunger Coalition which is working closely with Healthy Sheboygan County 2020 Nutrition groups. Obesity and Nutrition Strategy Three: Promote a lifespan of physical activity The hospital will develop a partnership with HSC 2020 and other community agencies to promote and increase physical activity. FY2019 Outcomes: The hospital continues to be actively engaged in Healthy Sheboygan County 2020 and is part of the ongoing discussion to convene a cross-sector group to develop strategies that will promote and increase physical activity for community members. Obesity and Nutrition Strategy Four: Promote best practice worksite wellness Wellness Council of America (WELCOA) Well County /Workplace Designation The Sheboygan County Activity and Nutrition Coalition (SCAN) Committee partnered with the Wellness Council of Wisconsin to engage and challenge local businesses to improve the health & wellbeing of the workforce in Sheboygan County. The coalition established a goal to achieve 'Sheboygan Well County' designation from the Wellness Council of America (WELCOA) by 2020. Sponsored locally by the Wellness Council of Wisconsin, Well City USA challenges local businesses and community leaders to work together and engage entire communities in improving the health and wellbeing of their workforces. Well City USA status is achieved when a minimum of 20 organizations that collectively employ at least 20% of a community's workforce become designated Well Workplaces within a three-year period. Each employer must complete WELCOA's Well Workplace Award application to document their progress in developing their worksite wellness initiatives. FY2019 Outcomes: HSC 2020 SCAN and HSHS St. Nicholas Hospital/Prevea continue work to achieve the designations of a Well County and a Well Workplace. Prevea staff actively serve on HSC 2020 Well County Group. Due to changes in the application process, the due date for the application has been extended until March 2020. We continue to work on the application which includes data gathering from the Health Risk Assessments and initiation of health coaching. As an outcome of the prioritization process, the following community health needs were also identified, but will not be addressed directly by the hospital for the reasons indicated: Jobs/Income and wages: Being a provider of health care services through inpatient and outpatient services, the hospital does not have the expertise or resources to take the lead on addressing this priority in the region. However, in our role as an employer, the hospital is involved in many initiatives to support employment within our community. Injury and violence: The hospital is not directly involved in initiatives dealing with the prevention of injuries and violence. HSHS St. Nicholas Hospital is a member of the local child death review committee which reviews childhood deaths in our county and works with other local organizations to administer programs and services to address this issue. Housing: Being a provider of health care services through inpatient and outpatient services, the hospital does not have the expertise or resources to address housing in the region. HSHS St. Nicholas Hospital does provide support to various community agencies that work directly within this scope. Examples include collection drives that provide the basics, including food for the local food bank and personal hygiene items for our local women's shelter. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - St. Nicholas Hospital. Presumptive eligibility provides individuals participating in one of the following categories with a 100% write off. These programs are granted by outside organizations based on screening criteria of less than 200% of the FPG. 1. Homelessness 2. Deceased with no estate 3. Mental incapacitation with no one to act on patient's behalf 4. Medicaid eligibility, but not on date of service or for non-covered services 5. Incarceration in a penal institution 6. Enrollment in the following assistance programs for low-income individuals: 6a. Temporary Assistance for Needy Families (TANF) 6b. Illinois Housing Development Authority's Rental Housing Support Program 7. Wisconsin Department of Health Services Housing Assistance Program 8. Participation in Women, Infants and Children programs (WIC); 9. Supplemental Nutrition Assistance Program (SNAP) eligibility; 10. Illinois Free Lunch and Breakfast Program; 11. Wisconsin Free Lunch Program; 12. Low Income Home Energy Assistance Program (LIHEAP); 13. Wisconsin Home Energy Assistance Program (WHEAP); 14. Enrollment in an organized community-based program providing access to medical care that assesses and documents limited low-income financial status as criteria; 15. Receipt of grant assistance for medical services 0 Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 2537669 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance CHARITY CARE IS CALCULATED BY DETERMINING THE TOTAL AMOUNT FROM PATIENT BILLING THAT IS WRITTEN OFF TO CHARITY CARE CHARGE CODES OR ALLOWANCES. THIS AMOUNT MATCHES THE NUMBER THAT IS REPORTED ON OUR FY2019 AUDITED FINANCIAL STATEMENTS. THE TOTAL CHARITY CARE DOLLAR AMOUNT IS THEN REDUCED TO COST BY APPLYING THE HOSPITAL'S COST TO CHARGE RATIO AS CALCULATED ON IRS SCHEDULE H - WORKSHEET J. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Self-pay patients are screened for verification of no insurance coverage. Once verification of no coverage has been completed, the guarantors will be screened for charity or uninsured discounts based on income levels. Those guarantors who do not qualify for charity through the screening process will be asked to provide proof of income in the form of a recent pay stub and/or recent tax return to determine the level of uninsured discounting. If no proof of income is provided or a guarantor's income is greater than 201% of the federal poverty level, the appropriate discount according to the established criteria up to 400% of the federal poverty level will be applied. The amount of money not collected from those self-pay patients who are not eligible for charity care is reported as bad debt. Allowances for Doubtful Accounts have been recorded based on an historical matrix, using collectability percentages by payor and aging category in accordance with HSHS Executive Policy #F-23, Valuation of Net Accounts Receivable. Percentages are based on historical experience at the hospital and adjusted for known limitations. The Hospital reports bad debt in accordance with Generally Accepted Accounting Principles (GAAP). Schedule H, Part III, Line 3 Bad Debt Expense Methodology HSHS St. Nicholas Hospital strongly believes that its charity care, and the related community benefit obtained from such care, is understated because of those patients who potentially qualify for charity care but do not wish to apply for it. In addition, some care is not classified as charity because of missing documentation on patient resources. Thus, the hospital's bad debt includes a portion that could be classified as charity care if application for such care was sought and/or completed. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The text of the footnote to the organization's financial statements that describes bad debt expense can be found on page 19 of the HSHS Consolidated Audit Report. Please also reference Footnote 2Q on page 14 for an explanation of how the financials account for bad debt. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs HSHS St. Nicholas Hospital continually strives to provide excellent patient care in the most cost effective fashion. Nonetheless, the Medicare program, in many cases, does not provide payment that covers the full cost of the care provided. Since it is the mission of the hospital to respond to community need, hospital management continually advocates for improved Medicare payment so that the cost of quality care to those patients who are not able to afford it is not compromised and is fairly subsidized by all payers. THE HOSPITAL COMPUTES THE UNPAID COSTS OF PROVIDING CARE TO MEDICARE PATIENTS BY COMPARING THE COST OF THE SERVICES TO THE REIMBURSEMENT RECEIVED FROM MEDICARE DURING THE YEAR. THE COST OF MEDICARE SERVICES IS CALCULATED BY APPLYING THE RATIO OF PATIENT CARE COST TO CHARGES TO THE ANNUAL MEDICARE CHARGES. THE PATIENT CARE COST IS DETERMINED BY REDUCING THE TOTAL ANNUAL OPERATING EXPENSE BY BAD DEBT EXPENSES, MEDICAID PROVIDER TAXES AND COMMUNITY BENEFIT EXPENSE. THE DIFFERENCE BETWEEN THE REIMBURSEMENT RECEIVED AND THE CALCULATED COST OF THE SERVICES IS REPORTED AS THE MEDICARE SHORTFALL. The hospital's Medicare shortfall at cost for FY2019 was nearly $22.5 million. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Every effort is made prior to, during, and after provision of medical services to determine whether a patient is eligible for charity/community care and to assist the patient in completing the application and providing adequate documentation. If the patient qualifies for charity/community care for the full balance of their account, the entire amount is written off to charity/community care and hence no debt collection is pursued. If the patient qualifies for charity/community care for a portion of their account balance, that portion is written off to charity/community care, with the patient being responsible for the remainder of the balance. Additionally, reasonable effort will be made to obtain third-party or government payer reimbursement on behalf of the patient. If those efforts are not fruitful, an offer will be extended to the patient to make installment payments on their balance. Only at such point that the patient defaults on installment payments or refuses to cooperate with the hospital's efforts to be reimbursed will the account be sent to collections. The hospital will make reasonable efforts to determine whether a patient is eligible under the financial assistance policy before it engages in an ECA. To the extent a patient is determined to be eligible for financial assistance under the FAP, the hospital will take all reasonably available measures to reverse any ECA taken against the patient to obtain payment for the care. Schedule H, Part V, Section B, Line 16a FAP website - ST. NICHOLAS HOSPITAL: Line 16a URL: http://www.hshs.org/FAP; Schedule H, Part V, Section B, Line 16b FAP Application website - ST. NICHOLAS HOSPITAL: Line 16b URL: http://www.hshs.org/FAP; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ST. NICHOLAS HOSPITAL: Line 16c URL: http://www.hshs.org/FAP; Schedule H, Part VI, Line 2 Needs assessment HSHS St. Nicholas Hospital is continually assessing the health care needs of the community through several avenues, including the Hospital Advisory Council which is representative of the community that the hospital serves. The Council meets regularly to discuss hospital services and the ability of the hospital to meet community health care needs. Agendas are purposely organized to include time for feedback from members on what they are hearing in the community. In addition, hospital colleagues represent the hospital on a variety of community groups which provides an opportunity to reach and serve the medically underserved, low income and minority populations within our community. Through this representation, the hospital becomes aware of emerging needs and is able to offer to address or support others to address these needs. In addition, feedback is solicited in patient surveys and the Patient Family Engagement Council. The hospital maintains a close relationship with the public health department which is also a good resource regarding the health of our community. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance HSHS St. Nicholas Hospital's community care (financial assistance program) brochures and applications are available on its website in both English and Spanish. The community care (financial assistance program) brochures and program are available to all patients regardless of whether they are insured or uninsured and are prominently displayed within the hospital Emergency Department and lobby waiting areas. The hospital also partners with Lakeshore Community Health Care, the local Federally Qualified Health Center, to make their patients aware of the hospital's financial Assistance program when the FQHC refers patients to SNS. The financial assistance program application may be obtained in the Patient Access department. Each hospital billing statement includes instructions for patients who need financial assistance. These patients are directed to follow up with our Patient Accounts Customer service. Applications are mailed based on screening. Point of Service uninsured patients: * Registration provides the Community Care application packet for any uninsured patients that present to our Emergency Department. * The scheduled appointments are contacted by a Financial Counselor either prior to service or upon arrival for their appointment. After normal business hours, the Registrar will provide the Community Care packet. * Inpatients are visited in their room by a Financial Counselor during normal business hours. All patients presenting and discharged during off-hours are contacted by a Financial Counselor based on a Self-Pay work queue. Patients are screened for the hospital's financial assistance program eligibility and for possible assistance through other government agency programs. Financial Counselors work with the patients through the Community Care application process and make referrals to the hospital contacted agency for assistance with eligibility and application process for any government programs. The contracted agency actively reaches out to patients who may need additional assistance or advocacy to apply for benefits, appeal denials, or who need transportation to government agencies to apply for benefits. Our on-site vendor, HRS Erase, provides personal visits to patients to screen for government programs. In addition, there are plans for the representative from HRS Erase to become a Certified Application Counselor for market place insurance, so the hospital can offer this service onsite. A system called Search America is sometimes utilized after failed follow-up attempts to reach the patient have been made to determine if the patient has the ability to pay. This system displays a federal poverty level determination and provides credit information which allow the user to see the probability of a patient's ability to pay. After assessing the information, a presumptive determination is made as to whether the patient qualifies for charity based on charity guidelines or if collection efforts are continued. Schedule H, Part VI, Line 4 Community information HSHS St. Nicholas Hospital (SNS) is an acute community hospital located in Sheboygan Wisconsin. The city is located on the western shore of Lake Michigan at the mouth of the Sheboygan River, about 55 miles north of Milwaukee and 60 mi south of Green Bay. The county totals 513 square miles and is bordered by Lake Michigan to the east, Manitowoc and Calumet counties to the north, Fond du Lac County to the west, and Washington and Ozaukee counties to the south. Sheboygan County has an estimated population of 115, 290 (2017). The city of Sheboygan is the largest city in the county with a population of 48,288 (2017). Two other cities, Sheboygan Falls and Plymouth have populations of 7,775 and 8,445 respectively (2017). The remainder of the county consists of small villages and rural residential settings. In Sheboygan County, over 36,000 people, which is approximately 30 percent of the County's total population, live outside cities and villages. Many rural residents face barriers related to access to housing, transportation, and foods that are safe, healthy, and affordable. These barriers can impact all residents, thought they are particularly problematic for those already struggling financially. There are two non-profit, general medical and surgical hospitals servicing the county. There are several outpatient clinics affiliated with the health systems which operate the two hospitals (HSHS/Prevea and Aurora Healthcare). Ascension and Holy Family Memorial also operate clinics within our county along with a small number of independent providers. In addition, there is a federally qualified healthcare center (Lakeshore Community Health Care) which provides medical, dental and behavioral health services. Sheboygan County contains a HPSA (health professional shortage area) for Medical, Dental, and Behavioral Health as well as a MUA (medically underserved area), per HRSA (Health Resources and Services Administration). HSHS St. Nicholas does not exclude Medically Underserved Areas, low income or minority population from its service area. The service area's racial profile is primarily white (85.6 percent), higher than the state (86.2 percent) and nation (72.4 percent). The largest minority populations in the service area are Hispanic or Latino (5.98 percent) and Hmong (5.25 percent) with other races making up the remaining 3 percent of the population. Wisconsin is home to the third largest Hmong population in the nation. Sheboygan County with has one of the largest Hmong populations in the state. When compared to other counties, Sheboygan County has a relatively high number of residents that are native Hmong speakers. Studies have shown that language and cultural barriers can have negative impact on an individual's health. Addressing social determinants of health is important for improving health and reducing longstanding disparities in health and health care. The median age of residents is 41.4 years which is older than the state median age of 39.4 years. The Hospital service area population is aging as much of the nation is as the population of Sheboygan County aged 60 and older comprises approximately 34% of the county population, or 50,907 individuals. Along with the aging population come increased health care costs with chronic disease. Studies indicate that the health of the aging population can be maintained, and chronic diseases reduced by promoting healthy behaviors and expanding prevention services. The median income of Sheboygan County residents is $53,713 which is approximately $300 dollars more than the Wisconsin median income of $53,357. 9.2% of population of is below the federal poverty guideline. A total of 18.9% of the hospital's and community's patients are uninsured or Medicaid recipients (6.2% uninsured and 12.7 % Medicaid). Socioeconomics is one of the most influential determinants in an individual's level of access to health care. Individuals with a lower socioeconomic status in the U.S. have lower levels of general health, insurance, in addition to less access to care. (American Journal of Public, Health 2000). Several large manufacturing firms, service industry, agriculture, and agriculture-related business are located in Sheboygan County and provide most of the employment opportunities. Schedule H, Part VI, Line 5 Promotion of community health As a healing ministry of the Catholic Church and an affiliate of Hospital Sisters Health System (HSHS), HSHS St. Nicholas Hospital is committed to delivering high quality, compassionate, and cost-effective health care services to all. Founded in 1890, the hospital brings a healing presence and improves the health of our community, especially those persons who are sick, poor, and disadvantaged. Because of the hospital's mission and heritage, the hospital is dedicated to promoting the health of Sheboygan County and surrounding areas. The hospital is governed by a Board of Directors, most of whom reside in the hospital's primary service area and are neither employees nor independent contractors of the hospital (nor family members thereof). The Board ensures that HSHS St. Nicholas is responding to community need. In FY2019 for example, Community Benefit staff presented to the Board on Community Involvement updating them on current initiatives related to the identified health focus areas. Additionally, our hospital Advisory Council, HSHS St. Nicholas Foundation and the Partners of St. Nicholas Hospital, whose volunteer members assist in many areas of the hospital, provide the hospital with additional connections to and insights into the larger community and its health care needs. Consistent with its exempt purpose, HSHS St. Nicholas Hospital has an open medical staff with privileges available to all qualified physicians in the area. The hospital also operates an emergency department that is open 24 hours to all persons regardless of their ability to pay. As a not-for-profit hospital, HSHS St. Nicholas Hospital reinvests surplus funds to support the mission of the organization and health of the community rather than distributing surplus funds as profits to shareholders or individuals. Funds not committed to ongoing operations are generally used to upgrade facilities, secure new technologies, improve patient care, and support initiatives designed to promote health and ensure access for all. Medical Office Building In April 2018, SNS and Prevea Health broke ground on a new medical office building on the hospital campus. The five-story building will house Prevea physicians and specialists, along with a lab. It also has the potential for other capabilities, such as imaging, to meet the health care demands of the market. Currently, Prevea Health's physician offices are scattered loosely outside and around the SNS campus, which makes coordination of care between the hospital and physicians a bit more complex than needed. With the new medical office building located directly on the hospital campus, providers and patients will be just steps away from the hospital allowing for more seamless coordination and better patient care experiences. In providing this space on the SNS campus for Prevea Health, SNS is securing its place in the market and on the move to gain market share. The medical office building is scheduled for completion in August 2019. Radiation Oncology Department Renovation During FY19, the Radiation Oncology Department started a renovation project to improve the opportunities for cancer care we can provide for our community. This included remodeling of the physical space to provide a more welcoming and comfortable environment for patients and staff. In addition, a TrueBeam linear accelerator will be installed replacing the current therapy equipment allowing the Hospital to utilize state-of-the-art radiation therapy equipment. The True Beam delivers highly-precise doses of radiation to the tumor(s) which can result in shorter treatments and improved patient experiences. The project is due to be completed Fall 2019. HSHS St. Nicholas Hospital also devotes significant resources to access for patients who cannot afford care, along with other community benefit. In FY2019, HSHS St. Nicholas Hospital provided more than $9.7 million in Community Benefit services, including financial assistance at cost, unpaid costs of Medicaid and other public programs, and a range of diverse programs designed to enhance access and improve community health. Additionally, in FY2019, HSHS St. Nicholas Hospital provided $203k (at cost) in uncompensated care to patients who did not qualify for charity care or public assistance and more than $22 million (at cost) in excess of Medicare payment for health care services. HSHS St. Nicholas Hospital provides a range of Community Benefit initiatives and programs that further our mission and long-standing commitment to our community. In many cases, these Community Benefits would not exist without the leadership role played by HSHS St. Nicholas Hospital and they often relieve a burden that would otherwise be carried by government. Schedule H, Part VI, Line 6 Affiliated health care system Headquartered in Springfield, Illinois, Hospital Sisters Health System (HSHS) is a highly integrated, multi-institutional health care system comprised of 16 hospitals and more than 200 physician practice sites in Illinois and Wisconsin. HSHS is sponsored by Hospital Sisters Ministries (HSM), which is a public juridic person of the Roman Catholic Church. HSHS continues the health care ministries begun by its founders, the Hospital Sisters of St. Francis, more than 140 years ago, in rural and midsized communities throughout Illinois and Wisconsin. HSHS provides compassionate, holistic, high quality, and cost-effective health care through its acute care hospitals, physician practices, home health programs, palliative and hospice programs, and community outreach services. In addition, HSHS affiliated hospitals include critical access facilities that offer essential health services that otherwise would not be available in many communities. Our mission calls us to reveal and embody Christ's healing love for all people, and we extend our high quality Franciscan health care ministry beyond the walls of our hospitals by providing community health improvement services with special emphasis on the poor and vulnerable. In addition to providing community health improvement services to the broader community, HSHS cares for everyone who comes to its facilities, regardless of their ability to pay. In tandem with a variety of cross sector community partners, HSHS's Community Benefit initiatives are strategically planned and professionally implemented to improve access to health care services; enhance the health of the community; advance medical or general health care knowledge; and relieve or reduce the burden of government to improve health. In FY2019, HSHS collectively provided $211.7 million in Community Benefit (9.2% of total hospital expenses). This amount included $27.7 million provided for Financial Assistance (a.k.a. Charity Care) and $142.3 million for unreimbursed care provided as part of the Medicaid program. In addition, HSHS hospitals committed significant resources to treat Medicare patients. The cost of providing services to primarily elderly beneficiaries of the Medicare program - in excess of governmental and managed care contract payments - was $279.9 million. HSHS hospitals also recorded $41.1 million in uncollectible accounts. While HSHS does not count the latter two amounts as Community Benefit, they nonetheless reflect our commitment to serving all persons in need of care. In addition to the dollars invested in our Community Benefit programs, HSHS continues to reinvest any surplus revenue from operations and investments into new medical technology, facility infrastructure and health care services in our communities. By doing so, we ensure our ability to meet the ongoing demand for high quality, efficient and easily accessible health care. Schedule H, Part VI, Line 7 State filing of community benefit report WI X X X X X false true false false false false false false false ANDREW J BAGNALL FORMER PRES/CEO WESTERN WI DIV 0 398881 0 15779 0 196643 0 77839 0 30673 0 719815 0 51004 THERESE B PANDL INTERIM PRES/ CEO EASTERN WISCONSIN DIVISION 0 702210 0 46929 0 175248 0 144623 0 29679 0 1098689 0 139297 Justin Selle President & CEO as of 8/20/18 0 92523 0 0 0 66195 0 9554 0 9589 0 177861 0 0 MICHAEL W COTTRELL BOARD MEMBER/HSHS CFO 0 657185 0 15342 0 155634 0 158581 0 31165 0 1017907 0 127730 ANN M CARR TREASURER 0 268272 0 4360 0 57197 0 89873 0 20590 0 440292 0 28431 MARY MARTIN CHIEF NURSING OFFICER 186213 0 4005 0 470 0 28842 0 27638 0 247168 0 0 0 GREG SIMIA DIVISION CFO 0 415076 0 0 0 41380 0 60580 0 28644 0 545680 0 0 ANDREA M ANGOTTI PHARMACIST 156152 0 1261 0 780 0 56905 0 23393 0 238491 0 0 0 SHALON EDSON DIRECTOR - CLINICAL 128377 0 0 0 450 0 13641 0 9002 0 151470 0 0 0 MELISSA PALECEK PHARMACY MANAGER 154926 0 0 0 0 0 13771 0 935 0 169632 0 0 0 CEANNE SIMMELINK PHARMACIST 126897 0 0 0 858 0 7475 0 27897 0 163127 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A IN SCHEDULE O. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan HSHS EXECUTIVES ELIGIBLE TO PARTICIPATE IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ARE DEFINED IN THE SERP PLAN DOCUMENTS;. THE SERP WAS ESTABLISHED TO PROVIDE ADDITIONAL RETIREMENT BENEFITS TO ENSURE REASONABLE MARKET COMPETITIVE BENEFITS IN ACCORDANCE WITH THE HSHS EXECUTIVE COMPENSATION PHILOSOPHY ESTABLISHED BY THE HSHS COMPENSATION COMMITTEE. THE PLAN PROVIDES A DEFINED RETIREMENT CONTRIBUTION TO PARTICIPANTS COMMENCING ON JANUARY 1, 2008, EQUAL TO A PERCENTAGE OF COMPENSATION AS DEFINED IN THE SERP PLAN DOCUMENTS FOR THE PLAN YEAR. PARTICIPANTS CONSTRUCTIVELY RECEIVE A DISTRIBUTION FROM THE PLAN NO LATER THAN MARCH 15TH OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR IN WHICH AN AMOUNT IS VESTED and TAXABLE PURSUANT TO A VESTING SCHEDULE AS SPECIFIED IN THE PLAN DOCUMENT. THE ACTUAL DISTRIBUTION OF THE VESTED BENEFIT UNDER THE PLAN IS PAID IN A SINGLE LUMP SUM TO THE PARTICIPANT OR THE PARTICIPANT'S BENEFICIARY UPON THE EARLIER OF THE PARTICIPANT'S TERMINATION OF EMPLOYMENT, DEATH, OR TOTAL AND PERMANENT DISABILITY. THE FOLLOWING INTERESTED PERSONS CONSTRUCTIVELY RECEIVED DEFERRALS TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2018; THESE DEFERRALS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). ANDREW J BAGNALL -- $52,032 ANN M. CARR -- $29,653 MICHAEL W. COTTRELL -- $84,073 THERESE B. PANDL -- $89,819 THE FOLLOWING INTERESTED PERSONS RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2018; THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III) AND SCHEDULE J, PART II, COLUMN (F), AS APPLICABLE. ANDREW J BAGNALL -- $51,004 ANN M. CARR -- $28,431 MICHAEL W. COTTRELL -- $127,730 THERESE B. PANDL -- $139,297 Form 990, Part III, Line 4a SURGICAL SERVICES ST. NICHOLAS HOSPITAL SURGICAL SERVICES ARE COMPRISED OF THE MAIN OR, STERILE PROCESSING, SCHEDULING, PACU, ANESTHESIA, ONE DAY SURGERY (ODS) AND THE SHEBOYGAN SURGERY CENTER (SSC). THE MAIN OR HAS 6 OPERATING SUITES, A C-SECTION SUITE AND A PROCEDURE ROOM. THE SSC HAS 3 OR SUITES AND 2 PROCEDURE ROOMS. SERVICES ARE AVAILABLE 24/7 ONLY AT THE MAIN HOSPITAL. IN FY2019 THERE WERE NEARLY 5,100 SURGICAL PROCEDURES PERFORMED. SURGICAL PROCEDURES INCLUDE GENERAL, ORTHOPEDIC, ENT, PODIATRY, PAIN MANAGEMENT, OPHTHALMOLOGY, GASTROENTEROLGY, PULMONOLOGY, UROLOGY, TRAUMA AND GYNECOLOGY. ANESTHESIA AND STERILE PROCESSING ALSO PROVIDE HOSPITAL-WIDE SERVICES TO INPATIENT NURSING, LABOR AND DELIVERY AND THE EMERGENCY DEPARTMENT. ODS SUPPORTS INFUSION AND INTERVENTIONAL RADIOLOGY PATIENTS BESIDES THE SURGICAL CASES. Form 990, Part III, Line 4b RADIOLOGY SERVICES ST. NICHOLAS HOSPITAL IMAGING SERVICES PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE. DURING FY2019 THE DEPARTMENT PERFORMED APPROXIMATELY 30,500 INPATIENT AND OUTPATIENT EXAMS AND PROCEDURES ANNUALLY. PATIENTS HAVE ACCESS TO THE LATEST TECHNOLOGY IN RADIOLOGY, COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING (MRI), NUCLEAR MEDICINE, POSITRON EMISSION TOMOGRAPHY (PET) AND ULTRASOUND. THE STAFF CONSISTS OF BOARD CERTIFIED RADIOLOGISTS AS WELL AS LICENSED AND CERTIFIED TECHNOLOGISTS, NURSES AND SONOGRAPHERS. THE MODALITIES ARE ACCREDITED AND UTILIZE STATE-OF-THE ART EQUIPMENT TO AFFORD THE RADIOLOGISTS OPTIMAL IMAGES FOR INTERPRETATION. THE DEPARTMENT AND HOSPITAL ARE ACCREDITED BY THE JOINT COMMISSION. Form 990, Part III, Line 4c EMERGENCY SERVICES ST. NICHOLAS HOSPITAL OPERATES A LEVEL IV TRAUMA CENTER/EMERGENCY DEPARTMENT THAT IS OPEN 24/7 AND STAFFED BY BOARD-CERTIFIED EMERGENCY MEDICINE PHYSICIAN SPECIALISTS. STAFF MEMBERS ARE TRAINED IN ADVANCED CARDIAC LIFE SUPPORT, EMERGENCY NURSING FOR PEDIATRICS AND TRAUMA NURSING. IN FY2019 THERE WERE NEARLY 13,500 VISITS TO THE EMERGENCY CENTER. LIKE ALL HOSPITAL SERVICES, EMERGENCY CARE IS PROVIDED REGARDLESS OF RACE, CREED, OR ABILITY TO PAY, AND FINANCIAL ASSISTANCE IS AVAILABLE AFTER CARE IS PROVIDED FOR THOSE IN NEED. Form 990, Part III, Line 4d Description of other program services (Expenses $ 80,330,929 including grants of $)(Revenue $ 71,024,267) OTHER PROGRAM SERVICES ST. NICHOLAS HOSPITAL PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT MEDICAL SERVICES TO THE COMMUNITY. BESIDES THE THREE LARGEST PROGRAM SERVICES IDENTIFIED IN PART III, ST. NICHOLAS HOSPITAL PROVIDES ADDITIONAL SERVICES INCLUDING A MEDICAL/SURGICAL FLOOR, INTENSIVE CARE UNIT, WOMEN AND INFANT SERVICES, HOME HEALTH AND HOSPICE CARE, CARDIAC SERVICES, WOUND CARE, RADIATION THERAPY, ORTHOPEDIC SERVICES, RENAL DIALYSIS, SLEEP CENTER SERVICES, AND A VARIETY OF ADDITIONAL MEDICAL SERVICES. ST. NICHOLAS HOSPITAL PROVIDES AN ARRAY OF COMMUNITY HEALTH SERVICES INCLUDING, BUT NOT EXCLUSIVE TO THE FOLLOWING, DIABETIC SCREENINGS, FLU SHOTS, FOOT CLINICS AND A VARIETY OF COMMUNITY EDUCATION CLASSES. IN ADDITION, ST. NICHOLAS HOSPITAL PARTNERS WITH SEVERAL PHYSICIAN GROUPS AND OTHER JOINT VENTURES THAT PROVIDE NEEDED MEDICAL SERVICES TO THE COMMUNITY. Form 990, Part IV, Line 24a TAX EXEMPT BONDS ST. NICHOLAS HOSPITAL HOLDS A LIABILITY ON ITS BOOKS FOR TAX-EXEMPT BONDS, WHICH IS AN ALLOCATION FROM ITS SOLE CORPORATE MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"). AS A RESULT, THIS QUESTION WAS ANSWERED NO, AND SCHEDULE K WILL BE COMPLETED ON THE HSSI FORM 990. Form 990, Part IV, Line 10 Endowment Funds The organization maintains temporarily and permanently restricted net assets on its balance sheet. Such funds are held by Hospital Sisters of St. Francis Foundation, Inc., a related tax-exempt organization. While these funds are held to further one or more exempt purposes of the filing organization, they are not maintained exclusively for the filing organization. The board of directors of Hospital Sisters of St. Francis Foundation, Inc. maintains ownership and ultimately authority and discretion over the use of these funds. Based on the above, the related amounts have not been reported as endowment funds on Part V of Schedule D. Form 990, Part VI, Line 13 WHISTLEBLOWER POLICY PROVISIONS WITHIN THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY PROVIDE PROTECTIONS FOR WHISTLEBLOWER TYPE ACTIVITIES. Form 990, Part VI, Line 16b JOINT VENTURES HOSPITAL SISTERS HEALTH SYSTEM ADOPTED A JOINT VENTURE COMPLIANCE PROGRAM POLICY EFFECTIVE ON JANUARY 1, 2012 FOR ALL SYSTEM HOSPITALS, INCLUDING ST. NICHOLAS HOSPITAL. THE OVERALL PURPOSE OF THE POLICY IS TO PROVIDE PRACTICAL GUIDELINES FOR ETHICAL BUSINESS CONDUCT, TO ACHIEVE COMPLIANCE, AND TO DETECT AND PREVENT VIOLATIONS OF APPLICABLE LAWS. THE POLICY REQUIRES ST. NICHOLAS HOSPITAL, AND ALL HSHS HOSPITALS, TO EVALUATE THEIR PARTICIPATION IN JOINT VENTURE ARRANGEMENTS, INCLUDING UNDER APPLICABLE FEDERAL TAX LAWS, AND TO SAFEGUARD ST. NICHOLAS HOSPITAL'S TAX EXEMPT STATUS WITH RESPECT TO ANY JOINT VENTURE ARRANGEMENTS. Form 990, Part VI, Line 1a Delegate broad authority to a committee PER ARTICLE 5.5 OF THE ORGANIZATION'S BY-LAWS, THE GOVERNING BODY DELEGATES BROAD AUTHORITY TO AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL BE VESTED WITH AND MAY IN ITS DISCRETION EXERCISE THE FULL POWERS, DUTIES, RESPONSIBILITIES, AND AUTHORITY OF THE BOARD EXCEPT WHERE PROHIBITED BY LAW AND SUBJECT TO ANY LIMITATIONS IMPOSED BY THE BYLAWS OR THE BOARD OF DIRECTORS. AS PROVIDED IN THE BY-LAWS, THE EXECUTIVE COMMITTEE SHALL CONSIST OF NO MORE THAN SIX MEMBERS, INCLUDING THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON, THE PRESIDENT AND AT LEAST TWO OTHER MEMBERS SELECTED FROM AMONG THE DIRECTORS BY THE BOARD. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE CORPORATE MEMBER OF ST. NICHOLAS HOSPITAL (THE CORPORATION) IS HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body PURSUANT TO SECTION 2.3 OF THE CORPORATION'S BYLAWS, THE ORGANIZATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, HAS THE RIGHT TO APPOINT AND REMOVE THE CORPORATION'S BOARD OF DIRECTORS. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders RESPONSIBILITY FOR THE POLICY AND OPERATIONS OF ST. NICHOLAS HOSPITAL (THE "CORPORATION") IS VESTED IN ITS BOARD OF DIRECTORS, EXCEPT WITH RESPECT TO SPECIFIC POWERS RESERVED IN THE CORPORATION'S BYLAWS TO THE CORPORATION'S MEMBER, HOSPITAL SISTERS SERVICES, INC. ("HSSI"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501 (C) (3) OF THE INTERNAL REVENUE CODE. THE MEMBER OF HSSI IS HOSPITAL SISTERS HEALTH SYSTEM ("HSHS"), AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501 (C) (3) OF THE INTERNAL REVENUE CODE. THE GOVERNANCE AND OPERATIONS OF THE CORPORATION ARE SUBJECT TO HSSI'S RIGHT TO EXERCISE THESE RESERVED POWERS WITH RESPECT TO THE CORPORATION AND ORGANIZATIONS OF WHICH THE CORPORATION IS EITHER, DIRECTLY OR INDIRECTLY, A CONTROLLING MEMBER OR A CONTROLLLING SHAREHOLDER ("AFFILIATES"). HSSI'S RIGHT TO EXERCISE CERTAIN OF THESE RESERVED POWERS IS, IN TURN, SUBJECT TO THE APPROVAL OF HSHS AND HSHS' MEMBERS. THE RESERVED POWERS INCLUDE ALL RIGHTS GRANTED TO HSSI BY LAW AND THE RIGHT TO: (A) ADOPT, APPROVE AMENDMENTS TO, OR AMNED ANY STATEMENT OF PHILOSOPHY, MISSION, MISSION INTEGRATION OR VALUES, OR ANY NAME, LOGO, OR MARK OF THE CORPORATION OR OF ANY AFFILIATE; (B) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF ANY AFFLILIATE; (C) ADOPT, APPROVE AMENDMENTS TO, OR AMEND THE BYLAWS OF THE CORPORATION OR OF ANY AFFILIATE; (D) APPOINT AND REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE OF THE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, AND THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE; (E) APPROVE THE RECOMMENDATION OF THE BOARD OF DIRECTORS TO APPOINT OR REMOVE THE BOARD OF DIRECTORS, ANY ONE OR MORE DIRECTORS OF THE CORPORATION OR OF ANY AFFILIATE, OR THE CHAIRPERSON AND PRESIDENT OF THE CORPORATION OR OF ANY AFFILIATE. (F) WITH RESPECT TO THE CORPORATION OR ANY AFFILIATE, APPROVE THE PURCHASE, SALE, ALIENATION, EXCHNAGE, LEASE, OR ENCUMBRANCE OF ANY REAL PROPERTY OF THE CORPORATION OR OF ANY AFFILIATE, WHICH PROPERTY HAS A VALUE IN EXCESS OF LIMITS SET FROM TIME TO TIME BY HSSI; (G) APPROVE THE OPERATING AND CAPITAL BUDGETS OF THE CORPORATION OR OF ANY AFFILIATE, AND ANY DEVIATIONS BY THE CORPORATION OR OF ANY AFFILATE FROM SUCH BUDGETS IN AN AMOUNT OR PERCENTAGE SPECIFIED BY HSSI FROM TIME TO TIME; (H) APPROVE THE STRAEGIC PLAN AND GOALS OF THE CORPORATION OR OF ANY AFFILIATE; (I) APPROVE THE SALE OF SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR OF ANY AFFILIATE; (J) APPROVE THE MERGER OR DISSOLUTION OF THE CORPORATION OR OF ANY AFFILIATE; (K) ADOPT OR AMEND THE PLAN FOR MINISTRY EDUCATION AND GOVERNANCE FOR THE CORPORATION AND ITS AFFILIATES; (L) APPROVE THE CORPORATION'S MISSION ACCOUNTABILITY REPORTS AND THOSE OF ANY AFFILIATE; (M) APPROVE THE FINANCIAL POLICIES AND PROCEDURES OF THE CORPORATION OR OF ANY AFFILIATE, AND APPROVE ANY DEVIATIONS FROM SUCH POLICIES AND PROCEDURES BY THE CORPORAITON OR ANY AFFILIATE; AND (N) ADOPT POLICIES TO IMPLEMENT THE RESERVED POWERS OF HSSI. Form 990, Part VI, Line 11b Review of form 990 by governing body THE HOSPITAL EMPLOYS CROWE LLP TO ASSIST IN THE OVERALL REVIEW AND ELECTRONIC SUBMISSION OF ITS FORM 990. CROWE LLP PROVIDES GUIDANCE IN IDENTIFYING CRITICAL ERRORS IN THE RETURN SUBMISSION AND FEEDBACK ON QUANTITATIVE AND QUALITATIVE RESPONSES. ADDITIONALLY, THE HOSPITAL CFO PERFORMS A THOROUGH REVIEW OF THE RETURN AND REVIEWS IT WITH THE HOSPITAL CEO AND/OR SENIOR LEADERS BEFORE PRESENTING IT IN ITS ENTIRETY TO THE HOSPITAL BOARD FOR QUESTIONING AND REVIEW PRIOR TO THE RETURN'S SIGNING AND SUBMISSION TO THE IRS. Form 990, Part VI, Line 12c Conflict of interest policy THE ORGANIZATION IS SUBJECT TO THE CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY ("POLICY") OF HOSPITAL SISTERS HEALTH SYSTEM, AN ILLINOIS NOT FOR PROFIT CORPORATION EXEMPT FROM FEDERAL TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A REVISED CORPORATE COMPLIANCE PROGRAM AND CONFLICT OF INTEREST POLICY HAVE BEEN IMPLEMENTED SINCE JANUARY, 2009 TO MANAGE CONFLICTS OF INTEREST USING A SYSTEM-WIDE PROTOCOL FOR DISCLOSURE STATEMENTS. IN ACCORDANCE WITH THE ORGANIZATON'S CONFLICT OF INTEREST POLICY, ALL COVERED PERSONS HAVE A DUTY TO COMPLY WITH THE CONFLICT OF INTEREST POLICY FOR ANY CONTRACT, TRANSACTION, RELATIONSHIP, OR ACTIVITY CONTEMPLATED, ENTERED INTO, OR CONDUCTED AT HSHS OR ITS AFFILIATES. THE POLICY DEFINES COVERED PERSONS AS BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS, BOARD DESIGNEES, SENIOR MANAGEMENT, MEMBERS OF ANY COMMITTEE THAT OVERSEES THE APPROVAL OF PHARMACEUTICALS AND MEDICAL DEVICES, AND ANY OTHER INDIVIDUAL WHO HOLDS A POSITION OF TRUST. ON AN ANNUAL BASIS, HSHS DISCLOSES A COPY OF THE CONFLICT OF INTEREST POLICY (AND ALL CORRESPONDING PROCEDURES, GUIDELINES, FORMS, AND TOOLS) TO ALL COVERED PERSONS AND ADVISES ALL COVERED PERSONS IN WRITING OF ANY SUBSTANTIVE CHANGES TO THIS POLICY AND SUCH RELATED MATERIALS. COVERED PERSONS ARE REQUIRED TO REVIEW AND COMPLETE THE CORRESPONDING CONFLICT OF INTEREST STATEMENT. THE SYSTEM OFFICE VICE PRESIDENT - SYSTEM RESPONSIBILITY, VICE PRESIDENT - RISK & COMPLIANCE, OR MEMBERS OF THE AUDIT AND INTEGRITY COMMITTEE ("COMMITTEE") ARE AVAILABLE TO ANSWER ANY QUESTIONS A COVERED PERSON MAY HAVE. IN ADDITION, IF, AT ANY TIME AFTER SUBMITTING AN ANNUAL CONFLICT OF INTEREST STATEMENT, A COVERED PERSON BECOMES AWARE OF AN INTEREST THAT HE OR SHE WOULD HAVE HAD TO DISCLOSE AT THE ANNUAL INTERVAL, THE COVERED PERSON IS REQUIRED PROMPTLY TO DISCLOSE THE INTEREST TO THE COMMITTEE USING THE HSHS CONFLICT OF INTEREST DISCLOSURE STATEMENT. COMPLETED CONFLICT OF INTEREST STATEMENTS ARE SUBMITTED TO THE COMMITTEE, WHICH IS RESPONSIBLE FOR IDENTIFYING, ASSESSING, AND MANAGING CONFLICTS OF INTEREST THAT ARISE IN THE COURSE OF CONDUCTING THE AFFAIRS OF HSHS AND ITS AFFILIATES. IF THE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE CONFLICT OF INTEREST POLICY REQUIRES HSHS NOT TO ENGAGE IN, OR ENTER INTO A PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY UNLESS THE COMMITTEE OR, WHERE NECESSARY, THE BOARD OF DIRECTORS (ACTING THROUGH ITS DISINTERESTED MEMBERS), HAS INVESTIGATED ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY AND, IN THE ABSENCE OF ALTERNATIVES THAT ARE IN THE BEST INTERESTS OF HSHS, HAS DETERMINED: 1. THAT, REGARDLESS OF WHETHER THE COVERED PERSON PARTICIPATES IN THE IMPLEMENTATION OF THE PROPOSED CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY; 2. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS IN THE BEST INTERESTS OF HSHS; 3. THE CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY IS FAIR AND REASONABLE FROM THE PERSPECTIVE OF HSHS; AND 4. HSHS CANNOT OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, ARRANGEMENT, OR ACTIVITY WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN DETERMINING WHETHER A CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR AND REASONABLE TO HSHS, THE COMMITTEE SHALL CONSIDER, WHERE APPLICABLE: 1. APPRAISALS OR OTHER INDEPENDENT VALUATIONS OF THE FAIR MARKET VALUE OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT; 2. INFORMATION REGARDING COMPARABLE CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS BETWEEN UNRELATED PARTIES; 3. OFFERS FROM COMPARABLE COMPETING ENTITIES; AND/OR 4. STUDIES OF COMPARABLE COMPENSATION ARRANGEMENTS. IN ANY CASE IN WHICH THE COMMITTEE FINDS, AFTER TAKING THE STEPS DESCRIBED ABOVE, THAT HSHS SHOULD PARTICIPATE IN A PROPOSED TRANSACTION OR ARRANGEMENT DESPITE THE EXISTENCE OF A CONFLICT OF INTEREST, THE COMMITTEE SHALL DEVELOP, IMPLEMENT, MONITOR, AND ENFORCE COMPLIANCE WITH A CONFLICT MANAGEMENT PLAN FOR MANAGING THE CONFLICT OF INTEREST AS IT CONSIDERS NECESSARY FOR SUCH FINDINGS TO REMAIN VALID THROUGHOUT THE LIFE OF THE CONTRACT, TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY. ALL CONFLICT MANAGEMENT PLANS SHALL: 1. STATE THAT THE COMMITTEE WILL OVERSEE, MONITOR, AND ENFORCE COMPLIANCE WITH THE PLAN THROUGHOUT THE COURSE OF THE STUDY AND SPECIFY MEANS FOR DOING SO, INCLUDING, WITHOUT LIMITATION, THAT THE APPROPRIATE INDIVIDUALS MUST PROVIDE THE COMMITTEE WITH WRITTEN REPORTS PERTAINING TO COMPLIANCE WITH THE CONFLICT MANAGEMENT PLAN, THAT THE COMMITTEE SHALL HAVE THE RIGHT TO AUDIT THE STUDY FOR SUCH COMPLIANCE AND THE RIGHT TO IMPOSE SANCTIONS FOR NON-COMPLIANCE; 2. STATE THAT THE PLAN MUST BE SHARED WITH COVERED PERSON WHOSE INTERESTS IT WAS DEVELOPED TO MANAGE; 3. STATE THAT THE PLAN MUST BE SHARED WITH, AND PERIODIC REPORTS ON COMPLIANCE WITH THE PLAN MUST BE PROVIDED TO, THE BOARD, SENIOR MANAGEMENT, AND/OR GOVERNMENT AGENCIES; AND 4. PROVIDE FOR SUCH OTHER MANAGEMENT STEPS AND MECHANISMS THE COMMITTEE CONSIDERS NECESSARY AND APPROPRIATE. IN ADDITION TO THE COMMITTEE, THE SYSTEM OFFICE VICE PRESIDENTS OF SYSTEM RESPONSIBILITY AND RISK & COMPLIANCE MAY RETAIN SUCH INDEPENDENT ADVISORS OR EXPERTS AS DEEMED NECESSARY TO ASSIST IN MAKING ITS DETERMINATIONS AND DECISIONS. IF THE COMMITTEE DETERMINES THAT THE CONTEMPLATED TRANSACTION, RELATIONSHIP, ARRANGEMENT, OR ACTIVITY CANNOT PROCEED DUE TO A CONFLICT OF INTEREST, THE COMMITTEE SHALL INFORM THE APPLICABLE COVERED PERSON OR DECISION-MAKING BODY OF SUCH DETERMINATION WITHIN ONE WEEK OF THE COMMITTEE MEETING AT WHICH THE CONTEMPLATED TRANSACTION WAS DISCUSSED. THE COMMITTEE SHALL DOCUMENT ITS REJECTION OF THE CONTEMPLATED TRANSACTION IN THE COMMITTEE'S MEETING MINUTES. Form 990, Part VI, Line 15a Process to establish compensation of top management official THE COMPENSATION COMMITTEE (COMMITTEE) IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THE COMMITTEE DEVELOPS A COMPENSATION PHILOSOPHY FOR THE SYSTEM AND ALL AFFILIATES. THE COMMITTEE SELECTS AND HIRES THE INDEPENDENT COMPENSATION CONSULTANT TO DEVELOP COMPARABILITY DATA AND ADVISE THE COMMITTEE DURING ITS DELIBERATIONS REGARDING ALL ELEMENTS OF TOTAL COMPENSATION FOR ALL HSHS EXECUTIVES, (the top management official, other officers and key employees). INTEGRATED HEALTHCARE STRATEGIES ("IHS"), THE CONSULTANTS UTILIZED BY THE COMMITTEE, USE DATA FROM MULTIPLE TAX-EXEMPT PEER GROUP SOURCES (derived from a full market review conducted every other year) TO DETERMINE SALARY RANGES, INCENTIVE OPPORTUNITY RANGES AND BENEFITS FOR THE HSHS executives. IHS THEN ASSISTS THE COMMITTEE IN PREPARING CONTEMPORANEOUS DOCUMENTATION OF ALL ACTIONS. EACH COMMITTEE MEETING IS CONDUCTED WITH THE INTENT TO CREATE A REBUTTABLE PRESUMPTION OF REASONABLENESS FOR ALL ELEMENTS OF EXECUTIVE TOTAL COMPENSATION. THE CHAIRMAN MAKES THIS DECLARATION AND ALSO INQUIRES IF THERE ARE ANY CONFLICTS OF INTEREST BY ANY ATTENDEES. ANY CONFLICTS ARE DISCLOSED AND THE COMMITTEE THEN ACTS IN A MANNER TO AVOID ANY CONFLICTED INDIVIDUAL PARTICIPATING IN ANY MANNER WHERE A CONFLICT MIGHT EXIST. AT THE END OF THE MEETING, THE COMMITTEE PREPARES CONTEMPORANEOUS MINUTES THAT RECORD ALL ACTIONS TAKEN DURING THE MEETING. The process for reviewing compensation by the compensation committee is completed each fiscal year. Form 990, Part VI, Line 15b Process to establish compensation of other employees PLEASE SEE RESPONSE TO FORM 990, PART VI, LINE 15A. Form 990, Part VI, Line 19 Required documents available to the public BOARD-APPROVED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC AT THIS TIME. Form 990, Part IX, Line 11g Other Fees PROFESSIONAL FEES - Total Expense: 1904331, Program Service Expense: 1539469, Management and General Expenses: 364862, Fundraising Expenses: ; ISC FEES - Total Expense: 4879659, Program Service Expense: 0, Management and General Expenses: 4879659, Fundraising Expenses: ; CONTRACT LABOR - Total Expense: 1515011, Program Service Expense: 1492543, Management and General Expenses: 22468, Fundraising Expenses: ; PURCHASED SERVICES - Total Expense: 31620333, Program Service Expense: 29428069, Management and General Expenses: 2192264, Fundraising Expenses: ; Shared Services - Total Expense: 1272983, Program Service Expense: , Management and General Expenses: 1272983, Fundraising Expenses: ; Form 990, Part X, Line 11 POOLED INVESTMENT ACCOUNT ST. NICHOLAS HOSPITAL'S CASH RESERVES ARE INVESTED IN A POOLED INVESTMENT ACCOUNT. PARTICIPATION IN THE POOLED FUND IS LIMITED TO THE 501(C)(3) HOSPITALS AND RELATED HEALTH SERVICES ORGANIZATIONS SPONSORED BY THE HOSPITAL SISTERS HEALTH SYSTEM. THE POOLED ACCOUNT CONSISTS OF CASH, AND EQUITY AND DEBT SECURITIES THAT ARE PUBLICLY TRADED. IN ACCORDANCE WITH THE PROVISIONS OF SFAS NO. 124 "ACCOUNTING FOR CERTAIN INVESTMENTS HELD BY NOT-FOR-PROFIT ORGANIZATIONS," INVESTMENTS IN EQUITY SECURITIES WITH READILY DETERMINABLE VALUES, AND ALL INVESTMENTS IN DEBT SECURITIES, ARE REPORTED AT FAIR VALUE ON THE BALANCE SHEET. INCOME, REALIZED AND UNREALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. INDIVIDUAL COMPONENTS OF ASSETS AND REVENUE ARE NOT IDENTIFIED TO THE PARTICIPANTS. Form 990, Part XI, Line 9 Other changes in net assets or fund balances CHANGE IN PENSION - -5167262; CHANGE IN TEMPORARILY RESTRICTED NET ASSETS - -177603; CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS - -364929; KIARA CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261417684 HEALTHCARE IL -1945270 3230896 HSSI PHYSICIAN CLINICAL INTEGRATION NETWORK LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371668647 HEALTHCARE IL 563783 11970191 KCIN HSHS ACO LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 320465666 HEALTHCARE & SOCIAL ASSISTANCE IL -381285 458242 KCIN HOSPITAL SISTERS HEALTH SYSTEM 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371058692 HEALTHCARE IL 501(c)(3) Type III-FI NA false HOSPITAL SISTERS OF ST FRANCIS FOUNDATION 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371186514 HEALTHCARE IL 501(c)(3) 7 HSHS true HOSPITAL SISTERS HEALTHCARE WEST INC 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 510157933 HEALTHCARE WI 501(c)(3) Type I HSSI true SACRED HEART HOSPITAL 990 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 390807060 HEALTHCARE WI 501(c)(3) 3 HSSI true ST ANTHONY'S HOSPITAL 503 N MAPLE STREET EFFINGHAM IL 62401 370661233 HEALTHCARE IL 501(c)(3) 3 HSSI true ST ELIZABETH'S HOSPITAL ONE ST ELIZABETHS BLVD OFALLON IL 62269 370663567 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOHN'S HOSPITAL 800 EAST CARPENTER STREET SPRINGFIELD IL 62769 370661238 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 9515 HOLY CROSS LANE BREESE IL 62230 371208459 HEALTHCARE IL 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 2661 COUNTY HIGHWAY 1 CHIPPEWA FALLS WI 54729 390810545 HEALTHCARE WI 501(c)(3) 3 HSSI true ST MARY'S HOSPITAL 1800 E LAKE SHORE DRIVE DECATUR IL 62521 370661244 HEALTHCARE IL 501(c)(3) 3 HSSI true ST MARY'S HOSPITAL 111 SPRING STREET STREATOR IL 61364 362169181 HEALTHCARE IL 501(c)(3) 3 HSSI true ST MARY'S MEDICAL CENTER 1762 SHAWANO AVENUE GREEN BAY WI 54303 390818682 HEALTHCARE WI 501(c)(3) 3 HSSI true ST VINCENT HOSPITAL 835 S VAN BUREN GREEN BAY WI 51301 390817529 HEALTHCARE WI 501(c)(3) 3 HSSI true ST JOSEPH'S HOSPITAL 12866 TROXLER AVENUE HIGHLAND IL 62249 370663568 HEALTHCARE IL 501(c)(3) 3 HSSI true ST FRANCIS HOSPITAL 1215 FRANCISCAN DRIVE LITCHFIELD IL 62056 370661236 HEALTHCARE IL 501(c)(3) 3 HSSI true HOSPITAL SISTERS SERVICES INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163402 HEALTHCARE IL 501(c)(3) Type III-FI HSHS true HSHS MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD IL 62703 263956318 HEALTHCARE IL 501(c)(3) Type III-FI HSSI true HSHS WISCONSIN MEDICAL GROUP INC 3215 EXECUTIVE PARK DRIVE SPRINGFIELD IL 62703 264515959 HEALTHCARE WI 501(c)(3) Type III-FI HSSI true ORANGE CROSS AMBULANCE INC 919 ASHLAND AVENUE SHEBOYGAN WI 53081 391860942 HEALTHCARE WI 501(c)(3) 10 ST NICHOLAS true UNITY LIMITED PARTNERSHIP 2366 OAK RIDGE CIRCLE DE PERE WI 54115 391750729 HEALTHCARE WI 501(c)(3) 10 HSSI true PRAIRIE EDUCATION & RESEARCH COOPERATIVE 317 NORTH 5TH STREET SPRINGFIELD IL 62701 371157915 HEALTHCARE IL 501(c)(3) 4 HSSI true ST CLARE MEMORIAL HOSPITAL 855 S MAIN STREET OCONTO FALLS WI 54154 390848401 HEALTHCARE WI 501(c)(3) 3 HSSI true HSHS HOLY FAMILY HOSPITAL 200 HEALTHCARE DRIVE GREENVILLE IL 62246 370792770 HEALTHCARE IL 501(c)(3) 3 HSSI true UTLAUT MEMORIAL FOUNDATION 200 HEALTHCARE DRIVE GREENVILLE IL 62246 371140166 FUNDRAISING IL 501(c)(3) Type II HSSI true HSHS GOOD SHEPHERD HOSPITAL INC 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 370512290 HEALTHCARE IL 501(c)(3) 3 HSSI true SHELBY MEMORIAL HOSPITAL EMPLOYEE BENEFIT TRUST 200 SOUTH CEDAR STREET SHELBYVILLE IL 62565 371778753 TRUST IL 501(a) GSS true PAIN CENTER OF WISCONSIN 4131 W LOOMIS ROAD SUITE 300 GREENFIELD WI 53221 263155343 HEALTHCARE WI ST VINCENT Related 742948 556009 false false 0.5 PAIN CENTER OF WISCONSIN - OCONTO FALLS LLC 4131 W LOOMIS ROAD SUITE 300 GREENFIELD WI 53221 364717036 HEALTHCARE WI ST CLARE Related 26375 142266 false false 0.5 CARPENTER STREET HOTEL LLC 525 NORTH SIXTH STREET SPRINGFIELD IL 62702 364128127 HOTEL IL LASANTE INC N/A 0 SPRINGFIELD URGENT CARE REAL ESTATE LLC PO BOX 19456 SPRINGFIELD IL 627949456 030413258 RENTAL REAL ESTATE IL LASANTE INC N/A 0 PRAIRIE HEART INSTITUTE MANAGEMENT COMPANY LLC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 261479945 MEDICAL IL HSHS Related -6697 9753 false true 1 SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP 4000 NORTH ILLINOIS STREET SWANSEA IL 62226 823633320 REAL ESTATE IL ST ELIZABETH'S Related 337078 1174120 false false 0.5 PRAIRIE HEART INSTITUTE ST JOHN'S 800 EAST CARPENTER STREET SPRINGFIELD IL 62769 371321197 HEALTHCARE IL HSHS Related 0 0 false false 1 KIARA INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163401 HEALTHCARE IL HSHS C Corporation 1 true LASANTE WISCONSIN INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 391572196 HEALTHCARE IL KIARA INC C Corporation true LASANTE INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 371163400 HEALTHCARE IL KIARA INC C Corporation true PRAIRIE CARDIOVASCULAR 619 EAST MASON SUITE 4P57 SPRINGFIELD IL 62701 371071858 HEALTHCARE IL KIARA INC C Corporation true PREVEA HEALTH SERVICES INC 2710 EXECUTIVE DRIVE GREEN BAY WI 54304 391839351 HEALTHCARE WI HSSI C Corporation 0.5 true PREVEA CLINIC INC 2710 EXECUTVE DRIVE GREEN BAY WI 54304 391839349 HEALTHCARE WI PHSI C Corporation true RENAISSANCE QUALITY INSURANCE LTD PO BOX 1159 GRAND CAYMAN CJ KY11102 980669953 SELF-INSURANCE CJ HSSI C Corporation 1 true OJV INC 4936 LAVERNA ROAD SPRINGFIELD IL 62707 460873384 HEALTHCARE IL LASANTE INC C Corporation true false false true false false false false false false true false false true true true true true true true Schedule R, Part V, Line 2 TRANSACTIONS WITH RELATED ENTITIES ANY TRANSACTIONS LISTED ON SCHEDULE R, PART V, LINE 1 AND NOT ON SCHEDULE R, PART V, LINE 2 ARE BETWEEN RELATED 501(C)(3) AND DO NOT REQUIRE REPORTING ON THIS SECTION. Schedule R, Part VII Related Organizations Due to the increasingly complex organization structure of Hospital Sisters Health System and Affiliates, the filing organization has elected to report all organizations within Hospital Sisters Health System as related, regardless of ownership interest or "control" as defined by the instructions to Schedule R. The intent of this reporting is to promote transparency and increase consistency across the numerous Form 990 submissions by Hospital Sisters Health System and Affiliates.